The impact that malnutrition at the time of starting antiretroviral therapy (ART) has on survival and the CD4 count response is not known. MethodsA retrospective cohort study of patients attending the national HIV referral centre in Singapore who had a CD4 count less than 250 cells/mL and a measurement of body weight performed at the time of starting ART was carried out. Demographic and clinical variables were extracted from an existing database. Body mass index (BMI) was calculated from the weight in kilograms divided by the square of the height in metres. Moderate to severe malnutrition was defined as BMI less than 17 kg/m 2 . Intent-to-treat Cox models were used to determine the predictors of survival. ResultsA total of 394 patients were included in the analysis, of whom 79 died during a median study follow-up of 2.4 years. Moderate to severe malnutrition was present in 16% of patients at the time of starting ART, and was found to be a significant independent predictor of death [hazard ratio (HR) 2.19, 95% confidence interval (CI) 1.29-3.73, P 5 0.004 for those with BMIo17 compared with those with BMI418.5] as were stage of disease (HR 2.47, 95% CI 1.20-5.07, P 5 0.014 for those who were at stage C compared with those at stage A) and the type of ART [HR 0.50, 95% CI 0.27-0.93, P 5 0.03 for highly active antiretroviral therapy (HAART) compared with non-HAART treatment]. Malnutrition did not impair the magnitude of the increase in CD4 count at 6 or 12 months. ConclusionsMalnutrition at the time of starting ART was significantly associated with decreased survival, but the effect appeared not to be mediated by impaired immune reconstitution. Given the increasing access to ART in developing countries and the high frequency of HIV-associated wasting, studies of nutritional therapy as an adjunct to the initiation of HAART are urgently needed. 323Studies conducted before the widespread use of ART showed that malnutrition was associated with diminished survival [4,5]. Analysis of a more contemporary cohort of patients, many of whom were taking highly active antiretroviral therapy (HAART), has shown that wasting still occurs and remains an important predictor of death [6,7]. However, no previous study has specifically examined the impact upon survival of malnutrition at the QJ;time of starting ART. It is possible that malnutrition may impair the immune response to ART, prolonging the period during which patients are at risk of opportunistic infection and directly or indirectly increasing the risk of death. Malnutrition may therefore represent a potentially reversible cause of increased mortality in patients who are initiating ART. We performed this analysis using data from a retrospective observational cohort study in order to examine the associations of malnutrition with survival and with CD4 count response in patients commencing ART. MethodsWe used data from the Singapore HIV Observational Cohort Study (SHOCS), a retrospective observational cohort study that has obtained complete data for the cohort of HIVinfected p...

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Background:It is well known that quite a large number of apparently healthy donors are not able to donate blood successfully because of varied reasons.Aim:We want to analyze the rate and various reasons for deferrals.Materials and Methods:A retrospective analysis of records of the donors, for 3 years, from January 2005 to December 2007 was done, in order to find out the rate and causes of deferral in four categories of age groups, both in male and female, in our Transfusion Medicine Centre, Bangalore, India.Result:There were 16,706 donors, of which 976 donors were deferred (5.84%) for various reasons. Of the 16,706 donors registered for donation, females constituted only 11.27%. And deferral rate was about five times more for female (19.85%) compared to male (4.06%). The three most common reasons for deferral in female were low hemoglobin levels, low body weight, and hypotension. The deferral rate was higher in the age group of 18-25 years and most common cause was low hemoglobin level. In male, the three most common reasons for deferral were hypertension, under weight, and low hemoglobin levels. The deferral rate varied from 4 to 15% as reported in the literature. The most common cause of deferral in our study and in several studies available in the literature is the same.

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ObjectivesTo investigate the major primary and contributory causes of death among HIV patients in Singapore. DesignA retrospective observational cohort study of all adult patients seen at the national referral centre for HIV in Singapore between 1985 and 2001. MethodsData were extracted from the patients' records by 10 trained health care workers. AIDS-defining conditions were established using predefined criteria. For each case, a single principal cause of death and up to three contributory causes were identified. ResultsA total of 1504 patients aged 17 years or over were seen before the end of 2001, of whom 504 have died. The most frequent principal causes of death were Mycobacterium avium (17.5%), Mycobacterium tuberculosis (9.7%), pneumonia (cause unknown) (6.5%) and Cryptococcus neoformans (6.7%). Three hundred and eighteen patients (63.1%) died from an AIDS-defining condition. ConclusionsThe causes of death were similar to those found in Western cohorts, except that disseminated M. avium was a more frequent cause of death.